Living with severe asthma can be risky. When inhalers and steroids are ineffective, the asthma attacks occur more frequently and can be life threatening. With each attack, the smooth muscle of the airway walls becomes thicker, creating an increasingly narrow space for oxygen to pass.
“An asthma exacerbation causes remodeling of the airway smooth muscle,” said Jonathan Kurman, MD, the director of interventional pulmonology for the Froedtert & the Medical College of Wisconsin health network. “Just like when a bodybuilder lifts weights, the muscle contracts and expands, growing larger and stronger. This leads to a vicious cycle.”
Radiofrequency energy opens airways
Nearly 25 million Americans have asthma , and 5-10% of asthma patients are diagnosed with severe asthma. While there is no cure for asthma, it is possible to reduce the smooth muscle layer using radiofrequency energy — a treatment for severe asthma known as bronchial thermoplasty. Bronchial thermoplasty is the only FDA-approved treatment for severe asthma that does not involve medication.
With an instrument called a bronchoscope, which is a small camera inserted through the nose or mouth, a pulmonologist accesses the airways in the lungs and delivers the radiofrequency energy. The energy penetrates the airway wall and shrinks the smooth muscle layer without damaging the airway lining.
“The bronchoscope is extremely precise,” Dr. Kurman said. “We deliver the energy to the targeted cells, then, we retract the catheter ever so slightly and deliver the energy again to a different group of cells, moving slowly up the airway.”
Bronchial thermoplasty is an outpatient procedure that takes place during three sessions over the course of several weeks to treat the entire airway system. The first session treats the right lower lobe of the lung, the second treats the left lower lobe and the third treats the upper lobes on both sides. The procedure is done under general anesthesia.
The treatment is successful for 80% of patients. For the other 20%, while there are no long-term adverse effects, symptoms may not improve.
Fewer asthma attacks, improved quality of life
People treated with bronchial thermoplasty benefit from a healthier, more normal life. A randomized clinical trial published in the American Journal of Respiratory and Critical Care Medicine found the average person who undergoes bronchial thermoplasty has a 32% reduction in asthma symptoms and an 84% reduction in asthma-related visits to the emergency room.
While people have fewer asthma attacks, the treatment is not a replacement for daily asthma medications, which are still necessary for long-term stability. However, in some cases, people treated with bronchial thermoplasty are able to discontinue daily oral steroids.
Asthma is treatable
An asthma attack can happen at any time. It may last a few minutes or have symptoms that last for hours or days. While asthma attacks can be life threatening, they are preventable. Identifying your triggers and taking your asthma medications as prescribed are key to preventing an asthma attack. Tracking your symptoms will also help you know when to seek care.
“If you are following your asthma treatment regimen and your symptoms are not under control, do not be satisfied,” Dr. Kurman said. “Ask your physician if there are better options for you and educate yourself about what they are.”
- Are you taking multiple asthma medications but still having asthma attacks?
- Are you adjusting your lifestyle to avoid asthma triggers?
- Are you missing work, school or daily activities because of severe asthma?
If the answer to any of these questions is yes, it may be time to consider treatment beyond medication alone.
Bronchial thermoplasty is a treatment option for people age 18 and older with severe asthma whose symptoms cannot be controlled with high doses of inhaled corticosteroids and/or systemic corticosteroids (like prednisone).
Most insurance plans, as well as Medicare, cover bronchial thermoplasty for eligible people.